Medical Features

What I Need to Know about Acupuncture for Stroke

Post on 28/11/16

Some Survivors wonder how alternative therapies could affect their post-stroke health. Licensed Chinese Medicine Physician Jeraldine Seah shares the traditional principles behind one popular treatment.


Acupuncture is an integral part of Traditional Chinese Medicine (TCM) and has been used for both prevention and treatment of various diseases. It involves the insertion of fine, sterile needles into specific acupuncture points found on meridians (pathways) in the body. With manipulation of the needles, de-qi sensation is being elicited. De-qi refers to a sensation of numbness, distension, or tingling at the needling site or may radiate along the corresponding meridian.

Acupuncture involves different techniques including the use of traditional body acupuncture points, auricular as well as scalp acupuncture. Similar to reflexology, auricular acupuncture stimulates reflex points on the ear which relieves conditions of a distal pathology. Scalp acupuncture is a therapeutic method where specific areas or lines of the scalp are needled. Pulsating electrical current may be applied to the acupuncture needles as a means of stimulating the acupuncture points (also known as electro-acupuncture). Acupuncture also includes moxibustion, a technique that involves the burning of mugwort (herbal leaf).

How Does Acupuncture Work?

 In TCM, the function of acupuncture is to clear blockages and restore the normal flow of Qi, thereby stimulating the body’s own natural healing system. Research has revealed that acupuncture can trigger multiple biological responses in the human body, including circulatory and biochemical effects. Such responses can occur close to the site of needling, or distally. These may result in the activation of neural pathways as well as the secretion of neurotransmitters, which affects various physiological systems.

The use of acupuncture for post stroke rehabilitation in China is based on extensive clinical research. It is widely used as a complementary therapy by Chinese patients to improve post stroke sensory, motor, speech and other neurological deficits. In the past, the lack of publications, poor study quality or inconclusive research in English journals may have impeded the consideration of its use as an adjunct to standard care in routine Western clinical practice.

However, there have been more and more clinical trials which demonstrate the positive effects of acupuncture as a complementary treatment modality for post stroke rehabilitation in the recent decades. Animal studies have revealed that the effects of acupuncture on stroke could be possibly due to the inhibition of post-ischemic inflammatory reaction and stimulation of neurogenesis and angiogenesis.

Applying Acupuncture for Stroke Survivors

Acupuncture treatment is commonly used for post-stroke paralysis, dysphagia, spasticity, pain and depression. It has been shown to improve motor function, independence in activities of daily living and quality of life. Utilizing both scalp and body acupuncture is a valuable method in the treatment of stroke. Generally, acupuncture points on the affected side are needled, whereas when administering scalp acupuncture, points on the motor area and foot-kinesthetic sensory area on the opposite side are employed. 

Time is crucial in stroke treatment. Early intervention is highly recommended. The frequency of treatment will be determined by the severity and duration of the condition and it changes during the course of the disease. Daily treatments are recommended in the early stage. Typically, each acupuncture treatment session will last about 20 to 25 minutes.

Safety of Acupuncture for Stroke Survivors

Acupuncture is a relatively inexpensive and safe treatment modality when delivered by an appropriately trained practitioner. Anticoagulants are commonly prescribed to stroke patients and the safety of acupuncture for patients on anticoagulant therapy are often a concern. A study on the “Safety of acupuncture treatments for patients taking warfarin or antiplatelet medications: Retrospective chart review study” published in European Journal of Integrative Medicine has revealed that acupuncture treatment appeared to be safe, even for patients taking warfarin or antiplatelet medications and those who have high INR. A total of 242 patients and 4,891 acupuncture treatments were identified in this study. No patients experienced serious adverse events such as extensive bleeding.

In conclusion, acupuncture is a safe and low cost adjunct to standard care in the treatment of stroke patients. Promising rehabilitation improvements can be achieved but further high-quality clinical trials would be needed to support implementation within clinical practice.


Jeraldine Seah is a licensed Chinese Medicine Physician and is practicing as an acupuncturist at Singapore General Hospital’s Acupuncture Services. She graduated with a Double Degree in Biomedical Sciences and Chinese Medicine from Nanyang Technological University and Beijing University of Chinese Medicine.


Editor’s Note: The views expressed in this article are the author’s own. Before commencing with any new form of post-stroke treatment, including alternative forms of therapy, please consult your primary physician.

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2 Comments

Wong Sow Wei says:

I am concerned that this article seems to covey the glowing and unqualified view that acupuncture can and will help a stroke survivor recover after a stroke. The fact that it is published on the Singapore National Stroke Association’s website also suggests that the Association endorses what is stated in the article and the use of acupuncture as part of post-stroke recovery.

This is an issue because stroke survivors and their caregivers, many of whom are afraid, desperate and vulnerable, will read the article and conclude that acupuncture will definitely help them.

The vague claims of efficacy and lack of objective statistics cited on the success rate of acupuncture in helping stroke survivors also raises concerns. The article talks about how there have been more and more clinical trials “in the recent decades” demonstrating the positive effects of acupuncture without actually explaining what these positive effects were, whether they were published in peer-reviewed journals or if these “clinical trials” were even performed on human subjects.

The reference to animal studies is confusing especially if no follow up human studies were conducted. The next part of this sentence is also not helpful as it merely implies how acupuncture may work but does not state that this is how acupuncture does actually help stroke survivors.

Assertions that, “research has revealed that acupuncture can trigger multiple biological responses” which “may result in the activation of neural pathways as well as the secretion of neurotransmitters, which affects various physiological systems”, are causally ambiguous and it seems to suggest that it is scientifically proven that acupuncture can help stroke survivors.

A worried stroke survivor or concerned caregiver would also struggle to understand how acupuncture, which functions to clear blockages and restore the normal flow of Qi, actually works to help in post-stroke recovery. What will be helpful is to explain in a balanced way how acupuncture and this restoration of the flow of Qi helps a stroke survivor in his rehabilitation and recovery, if there are any contrary views about the effectiveness of acupuncture, what the objective success rates are, if there are any downsides and the existence and relative effectiveness of competing forms of treatment.

Jeraldine Seah says:

We thank Mr Wong Sow Wei for his insightful comments. The previous article “What I Need to Know about Acupuncture for Stroke” was written for a broader intended audience and hence citations with regards to acupuncture practice were not included.

The inconclusive evidence for the effectiveness of acupuncture for stroke, mainly due to poor methodological quality and small sample sizes (*1,2) may have impeded the consideration of its use as an adjunct to standard care in routine Western clinical practice.

However, various positive effects of acupuncture for post stroke rehabilitation demonstrated in clinical trials performed on human subjects have been published in peer-reviewed journals (*3,4,5). Acupuncture has been found to potentially improve neurologic deficits, swallowing disorder, cognitive impairment, and lower extremity function in patients with mil sd to moderate acute ischemic stroke in a multicenter randomized controlled trial (*3). Improvements from acupuncture treatment were observed in National Institutes of Health Stroke Scale (p < 0.001), videofluoroscopic swallowing study (p < 0.001), Mini-Mental State Examination (p < 0.001), Montreal Cognitive Assessment (p = 0.001), but not obtained from Fugl-Meyer Assessment (p = 0.228). A significant improvement in FMA lower extremity subscale appeared in acupuncture group AG (p = 0.020), but no significant difference was found for the upper extremity subscale (p = 0.707). More patients with swallowing disorder recovered in AG (p = 0.037)(*3).

Series of animal studies have demonstrated that electro-acupuncture might be a potential method in reducing the neural damages associated with stroke (*6). However, there are no human trials after the mechanistic studies possibly due to difficulties in translating tightly structured animal stroke models to complex human clinical scenarios7.

To understand how the restoration of the flow of qi helps a stroke survivor in his rehabilitation and recovery, we have to comprehend that the etiology of stroke from a TCM perspective differs from that of a Western scientific perspective. The fundamental treatment principle of acupuncture is to eliminate the underlying pathogenic factors and restore the patient’s body resistance. Acupuncture improves the flow of qi and blood in the body, relieves stagnation and expels underlying pathogenic factors which may in turn help to relieve post stroke disabilities.

The article was not meant to suggest that acupuncture will definitely help all stroke survivors in their rehabilitation. Like any other form of treatment modalities, acupuncture may not be suitable for all patients. It is crucial to note that there are many factors such as the severity of stroke and the duration of the condition which influence a patient’s suitability for treatment. Patients must consult their primary physician before commencing any complementary alternative forms of therapy and the TCM practitioner/acupuncturist will also assess their suitability for acupuncture treatment. Additionally, patients will be reassessed during the course of treatment.

During a TCM consultation, physicians should advise patients about the course of treatment, as well as potential benefits and drawbacks, alternative treatment, likelihood of treatment success and a possibility of no improvement. Acupuncture is not intended and should not be pursued as a substitute for patients’ standard routine Western treatment. Its use as an adjunct to standard care and other existing rehabilitation techniques (such as physiotherapy, occupational therapy and speech therapy) may be considered in post stroke rehabilitation.

We thank Mr Wong for his astute observations.

*References

1. Zhao XF, Du Y, Liu PG, Wang S. Acupuncture for stroke: evidence of effectiveness, safety, and cost from systematic reviews. Top Stroke Rehabil. 2012; 19(3): 226-233
2. Yang A, Wu HM, Tang JL, Xu L, Yang M, Liu GJ. Acupuncture for stroke rehabilitation. Cochrane Database Syst Rev. 2016; 8
3. Chen L, Fang J, Ma R, Gu X, et al. Additional effects of acupuncture on early comprehensive rehabilitation in patients with mild to moderate acute ischemic stroke: a multicenter randomized controlled trial. BMC Complementary and Alternative Medicine. 2016; 16:226
4. Lee SH, Lim SM. Acupuncture for insomnia after stroke: a systematic review and meta-analysis. BMC Complementary and Alternative Medicine. 2016; 16:228
5. Vados L, Ferreira A, Zhao S, Vercelino R, Wang S. Effectiveness of acupuncture combined with rehabilitation for treatment of acute or subacute stroke: a systematic review. Acupunct Med. 2015; 33:3 180-187
6. Feng R, Zhang F. The neuroprotective effect of electro-acupuncture against ischemic stroke in animal model: a review. Afr J Tradit Complement Altern Med. 2014; 3:25–9. 

7. Wayne A, Brett S‬. Handbook of Neuroemergency Clinical Trials. 2006.

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